<!doctype html>
<html lang="zh-CN">
<head>
    <include file="include/head" title="预约-填写体检人信息" />
</head>

<body>
	<div class="header-blank"></div>
    <div class="header">
		预约-填写体检人信息
		<span class="left">
			<a href="{:U('Index/booking_step2_date',array('id'=>$_GET['id'],'unit_id'=>$_GET['unit_id']))}"><span class="glyphicon glyphicon-chevron-left" aria-hidden="true"></span></a>
		</span>
	</div>
	
	<div class="profile-main">
		<form method="post" name="form" action="{:U('Index/booking_step4_final')}">
			<div class="profile-item">
				姓名<br/>
				<input type="text" name="name" /><br/>
			</div>
			<div class="profile-item">
				性别<br/>
				<input type="radio" name="sex" value="男"checked />男&nbsp;&nbsp;&nbsp;&nbsp;
				<input type="radio" name="sex" value="女" />女
			</div>
			<div class="profile-item">
				年龄<br/>
				<input type="text" name="age" /><br/>
			</div>
			<div class="profile-item">
				婚否<br/>
				<input type="radio" name="hunfou" value="已婚"checked />已婚&nbsp;&nbsp;&nbsp;&nbsp;
				<input type="radio" name="hunfou" value="未婚" />未婚&nbsp;&nbsp;&nbsp;&nbsp;
				<input type="radio" name="hunfou" value="离异" />离异
			</div>
			<div class="profile-item">
				身份证号码<br/>
				<input type="text" name="id_card" /><br/>
			</div>
			<div class="profile-item">
				手机号码<br/>
				<input type="text" name="mobile" /><br/>
			</div>
			<div class="profile-item">
				备注<br/>
				<input type="text" name="bz" /><br/>
			</div>
			
			<div class="profile-item">
				<input type="hidden" name="id" value="{$_GET['id']}" />
				<input type="hidden" name="unit_id" value="{$_GET['unit_id']}" />
				<input type="hidden" name="booking_config_id" value="{$_GET['booking_config_id']}" />
				<input type="submit" class="btn" value="提交" />
			</div>
		</form>
	</div>
	
	<include file="include/bottom" />

</body>
</html>